Liver & intrahepatic bile ducts

Hepatocellular carcinoma

HCC - scirrhous type



Last author update: 20 October 2022
Last staff update: 20 October 2022

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PubMed Search: Scirrhous hepatocellular carcinoma

Daffolyn Rachael Fels Elliott, M.D., Ph.D.
Ryan M. Gill, M.D., Ph.D.
Page views in 2021: 3,468
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Cite this page: Fels Elliott DR, Gill RM. HCC - scirrhous type. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/livertumorscirrhousHCC.html. Accessed December 9th, 2022.
Definition / general
  • Subtype of hepatocellular carcinoma (HCC) designated by the WHO, with abundant fibrous stroma separating nests and trabecula of tumor cells
Essential features
  • Unencapsulated, often subcapsular location, may have satellite lesions
  • Abundant fibrous stroma (> 50% of tumor) but lacks central scar or radiating fibrous bands
  • May mimic intrahepatic cholangiocarcinoma on imaging and gross evaluation
Terminology
  • Also called sclerosing variant of HCC
ICD coding
  • ICD-10: C22.7 - other specified carcinomas of liver
Epidemiology
Sites
  • Liver, often subcapsular
Pathophysiology
Etiology
Clinical features
Diagnosis
  • Imaging modalities for diagnosis of HCC: multiphasic computed tomography (CT) or magnetic resonance imaging (MRI)
  • Tissue biopsy is indicated if imaging not diagnostic of HCC
Laboratory
  • Elevation in serum alpha fetoprotein (AFP)
Radiology description
Radiology images

Images hosted on other servers:

CT scans

Prognostic factors
Case reports
Treatment
Gross description
Gross images

Images hosted on other servers:

Firm, whitish tumor

Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Ryan M. Gill, M.D., Ph.D. and Maura F. O’Neil, M.D.

Unencapsulated

Fibrous stroma

Cytologic features


Core biopsy

CK7

Glypican 3

HepPar1

Cytology description
  • Cells are polygonal with distinct cell membranes, high N:C ratio and round nuclei and may have prominent nucleoli (similar to moderately differentiated HCC)
Positive stains
Negative stains
Molecular / cytogenetics description
Sample pathology report
  • Liver, mass, partial hepatectomy:
    • Scirrhous hepatocellular carcinoma (see comment)
    • Comment: This tumor shows histologic features of scirrhous hepatocellular carcinoma with nests and trabecula of hepatoid cells within a dense fibrous stroma. The tumor cells show positive staining for glypican 3, arginase1 and CK7, as is typical for this variant.
Differential diagnosis
Board review style question #1

Which of the following is true regarding this variant of hepatocellular carcinoma?

  1. Abundant eosinophilic cytoplasm
  2. Abundant fibrous stroma
  3. Central scar
  4. Lamellar fibrous bands
  5. Prominent nucleoli
Board review style answer #1
B. Abundant fibrous stroma

Comment Here

Reference: HCC - scirrhous type
Board review style question #2
Which of the following is true regarding the scirrhous variant of hepatocellular carcinoma?

  1. Association with hypocalcemia has been described
  2. CK7 and CK19 are often negative
  3. It is associated with TSC1 / TSC2 mutations
  4. There is often necrosis or hemorrhage
Board review style answer #2
C. It is associated with TSC1 / TSC2 mutations

Comment Here

Reference: HCC - scirrhous type
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